[A case of traumatic inferior mesenteric arteriovenous fistula]

Curative embolization of iatrogenic inferior mesenteric arteriovenous fistula 14 years after right hemicolectomy

Inferior mesenteric arteriovenous fistula (IMAVF) is a rare condition with 40 reported cases. It can be of congenital, idiopathic or acquired etiology. Acquired IMAVF occurs after trauma or has an iatrogenic origin due to abdominal interventions, mainly operations involving the left hemi-colon. A new case of iatrogenic IMAVF is described, which became symptomatic 13 years after right hemicolectomy and was diagnosed radiologically one year later. This case was treated successfully by means of endovascular arterial embolization. To our knowledge, this is only the second reported case of acquired IMAVF following right hemicolectomy.

A rare case of simultaneous rectal and gastric carcinomas accompanied with inferior mesenteric arterioportal fistula: case report

BACKGROUND

Inferior mesenteric arterioportal fistula (APF) is rare as only 35 case reports in the literature. We herein presented a case of simultaneously double cancer in the rectum and stomach with inferior mesenteric APF, which is the first case report by searching using PubMed. Combination of interventional embolization and surgical operation seemed to be optimal treatment for avoiding postoperative complications and the curability.

CASE PRESENTATION

A 66-year-old male with epigastric pain was admitted to a practitioner. He underwent a gastroscopy with biopsy, and cancer located in the lesser curvature of the gastric cardia was found. Enhanced CT did not reveal wall thickening of the stomach and distant metastases, but several swollen lymph nodes were observed in the right cardia. In the arterial phase, dilation of inferior mesenteric vein (IMV) and superior rectal artery (SRA) were noted, which raised suspicions of an arterioportal communication. Colonoscopy revealed a type 2 rectal tumor located 12 cm from the anal verge. The histological diagnosis of well-differentiated tubular adenocarcinoma was confirmed by biopsy. At a first step, we planned to perform a radiological embolization of inflow vessels to APFs except for SRA. Additionally, we determined the interval time of 1 month between the first low anterior rectal resection and the sequential gastrectomy for the purpose of decreasing portal pressure. The postoperative course was uneventful without hemorrhagic complications, and S-1 was taken internally 1 year as adjuvant chemotherapy for gastric cancer. The patient still lives without recurrence of this cancer with APF and portal vein thrombosis 2.5 years after the aforementioned surgeries.

CONCLUSION

Inferior mesenteric APF and/or arteriovenous fistula (AVF) would be consisted of the several inflow arteries as superior rectal, internal iliac, and median sacral arteries, and outflow veins as inferior mesenteric, internal iliac, and median sacral veins. To determine the therapeutic strategy for left-sided colorectal cancers with abnormal vessel communications of the pelvis, it is significant to comprehend distribution and component vessels of APF and/or AVF.

Spontaneous inferior mesenteric arteriovenous fistula as a cause of severe portal hypertension and cardiomyopathy

Inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV) fistulas or malformations are extremely rare, with only 36 cases reported. Low incidence and nonspecific clinical signs and symptoms make mesenteric arteriovenous fistulas difficult to diagnose. We describe a case of a primary IMA-IMV fistula. Our patient presented with severe portal hypertension and cardiomyopathy along with robust arteriovenous connections between the IMA and IMV. Arterial embolization in this patient had to be followed by venous embolization for successful resolution of portal hypertension and cardiomyopathy. This case also highlights that close outpatient monitoring for treatment failure and recurrence is necessary for this disease process.

Inferior mesenteric arteriovenous fistula with nonpulsatile abdominal mass: A case report and a mini-review

RATIONALE

Inferior mesenteric arteriovenous fistula (IMAVF) is a rare condition principally characterized by portal hypertension and ischemic bowel disease. Up to now, only 30 cases have been reported. Presented here is an IMAVF patient with nonpulsatile abdominal mass as the main manifestation.

PATIENT CONCERNS

A 62-year-old Chinese male who complained of abdominal discomfort for a month was admitted to our hospital. Physical examination revealed a hard and hardly mobile mass.

DIAGNOSES

Space-occupying lesions were first suspected but endoscopy did not reveal any masses. The computed tomography angiography exhibited no definite boundary between the inferior mesenteric artery and vein. The patient was diagnosed with IMAVF.

INTERVENTIONS

The treatment of IMAVF mainly includes intra-arterial embolization and surgery. In our case, fistulas were complex and the patient had symptoms of colon ischemia, so we suggested a surgical resection instead of embolization. And the postoperative biopsy also confirmed the diagnosis.

OUTCOMES

After surgery, gastrointestinal symptoms disappeared and the patient began to gain weight gradually. During the follow-up, colonoscopy showed that the anastomotic astium and colonic mucosa were normal.

LESSONS

Analysis of the case showed that computed tomography angiography is an important auxiliary examination for establishing the diagnosis of IMAVF and surgery is an effective treatment.

Inferior mesenteric arteriovenous fistula

Arteriovenous fistula (AVF) involving the inferior mesenteric artery and vein is very rare with only 33 cases described in the literature and may be of congenital or acquired (iatrogenic or traumatic) or idiopathic etiology. The pathophysiology of AVF that acts as a left-to-right shunt has accounted for clinical signs and symptoms associated with ischemic colitis, portal hypertension, and heart failure. A low incidence and nonspecific clinical signs and symptoms such as abdominal pain, thrill and mass, lower and upper gastrointestinal bleeding make it difficult to establish a diagnosis of inferior mesenteric AVF. Diagnosis of inferior mesenteric AVF is usually established by radiological or intraoperative examination. We report a case of idiopathic inferior mesenteric AVF causing ischemic colitis in a 56-year-old man that was diagnosed preoperatively by multidetector computed tomography and angiography and successfully treated by surgical resection.

Mesenteric Lymph Node Hamartoma (Castleman's Disease) in Association with Superior Mesenteric Arteriovenous Fistula

We present a case of 21-year-old female patient with history of pain abdomen and abdominal distension. The patient also had oedema of the limbs, puffiness of the face, pallor and palpable mass in the abdomen. Ultrasonography of the abdomen and computed tomographic angiogram was done and it showed presence of vascular mass along with arteriovenous malformation in the mesentry of small gut between distal branches of superior mesenteric artery and vein. Surgical excision of the mass with ligation and division of the arteriovenous malformation was done through midline laparotomy. Histopathological examination was consistent with the diagnosis of Castleman's disease. The Patient recovered well and was discharged after seven days.

Idiopathic inferior mesenteric arteriovenous fistula: a rare cause of pulsatile abdominal mass

Inferior mesenteric arteriovenous fistula (AVF) is an extremely rare vascular abnormality which may be idiopathic or secondary to previous trauma or surgery, and it may result in portal hypertension or ischemic colitis if left untreated. Imaging can help accurately diagnose visceral AVFs and create a vascular map to display the feeding artery and draining vein before the surgery; however, multidetector computed tomography (MDCT) angiography of inferior mesenteric AVF is not well documented in the literature. In this article, the authors report a case of inferior mesenteric AVF in a 48-year-old woman evaluated for left-sided abdominal pain and diagnosed preoperatively by MDCT angiography. Surgical excision of the AVF was successfully performed, and the postoperative course was uneventful.